More Medicare Advantage competition and increasing benefits confuse beneficiaries, as CMS fails to provide adequate guidance or tools to assist seniors or their caretakers.
Earlier today, Medicare Navigators announced a warning that seniors who do not compare available Medicare Advantage plans for 2019 will lose out on significant cost saving opportunities. Even as the Centers for Medicare & Medicaid Services (CMS) has announced record growth in Medicare Advantage (MA) plan and Medicare Part D plan (PDP) choices and enrollments, the vast majority of seniors don't shop and compare annually. Medicare beneficiaries can use the Medicare Navigators MA and PDP plan tools (https://medicarenavigators.com) to explore options and costs in their area. Other sites offer their own methods of showing Medicare plan details.
For Medicare beneficiaries, now’s the time to make changes that will take effect January 1, 2019. It's Medicare open enrollment season, and beneficiaries can choose a new Medicare Advantage or Part D plan, or switch back to Original Medicare. Open enrollment ends December 7.
Although the addition of hundreds of new MA plan options in 2019 might seem like a big win for seniors, for most beneficiaries it only serves to complicated matters. The CMS announcement highlights an increase from 3,100 MA plans in 2018 to 3,700 in 2019. Over 90 percent of seniors wanting to join a Medicare Advantage plan will need to compare 10 or more plans to find the best option. Most big cities have 20 or more plan options.
“If you don’t shop around, you’re probably paying more than you should,” says D.Wayne Bynon, general manager at MedicareNavigators.com. You can research and compare Medicare Plans for 2019 using the Medicare Navigators plan comparison tool or the MA Finder tool on Medicare.gov. The challenge is doing a head-to-head comparison to find the best plan for your personal health and financial situation. Thus far, there simply isn't an ideal solution.
According to Bynon,"The lack of accurate plan comparison tools highlights why so many seniors feel Medicare Advantage plans are bad and choose a Medicare Supplement plan instead, even though it costs more. This is exactly why Medicare Navigators is investing in the development of software that balances the needs of the individual with the insurance coverage available in their area." Traditionally, this is the value offered by health insurance agents and brokers, but many seniors and their families prefer to shop and compare online.
As a reminder, Medicare Supplements, also known as Medigap plans, are not part of the annual open enrollment period. You can add or change a Medigap policy at any time. However, outside of certain circumstances, carriers can charge you more or deny coverage based on your health status.
On the subject of Medicare Advantage vs. Medicare Supplements, Bynon continues, "Many seniors give Medicare Advantage a bad rap because you must use the plan's network of healthcare providers. This highlights a major difference between the two types of insurance. As a general rule, I advise seniors in excellent health, who rarely see a doctor, to consider Medicare Advantage for its cost savings. I advise seniors with chronic health conditions and/or adequate income to consider a Medicare Supplement for its convenience and financial security."
Seniors evaluating a Medicare Advantage vs. Medigap decision should consider how much a MA plan could cost them in the event of a serious illness or accident. Unlike Original Medicare, including Medigap coverage, Medicare Advantage plans have annual maximum out-of-pocket (MOOP) limits. In 2019, MOOP is up to $6,700 for in-network care, which does not include your monthly premiums or prescriptions.
"Anyone considering a plan with a $6,700 MOOP should really investigate Medigap Plan N," says D.Wayne Bynon. "Plan N offers complete Part A (hospital) gap coverage, and it covers 100% of your Medicare Part B coinsurance costs, except a $20 co-payment for office visits and up to $50 for emergency room visits." For healthy people, Medicare Supplement N, which costs significantly less than the top-of-the-line Plan F, has a lot less risk than a high MOOP Medicare Advantage plan. Seniors can check out who offers Plan N in their state, as well as the starting monthly rates, using the free Medicare Navigators supplements tool (https://medicarenavigators.com/medicare-supplements/).
By now, everyone should have their “annual notice of change,” which outlines changes to coverage for the coming year. It's important to actually read it. "A lot of folks never even bother to open these things up," claims Bynon. "Not reading it simply means you're flying blind." Medicare's annual notice warns you of changes to your drug plan that can cost you money as well as changes to the network of doctors and hospitals who participate in the plan.
Even if you’re happy with your coverage going forward, experts say you should explore your options. Hundreds of counties are getting plans from new carriers offering more benefits, options and lower premiums. Plus, within the same county, there are significant differences in how much medications cost under different Part D drug plans and from different pharmacies.
You don’t need a Part D drug plan if you have Medicare Advantage, but you do if you have Original Medicare and a supplement. Most Medicare Advantage plans include a Part D plan. You can find Part D drug plans and Medicare Advantage plans on Plan Finder, where you’ll be able to compare your total costs for each offering. But to dig into specific coverage details, you may need to call carriers directly. Medicare Navigators conveniently provides carrier website and contact information on their plan pages.
If comparing plans feels overwhelming, you can call your State Health Insurance Assistance Program, also known as SHIP. “They help people explore their options all day long,” Bynon says. “And they’re unbiased. Unlike insurance agents, they don't get paid commissions.”
Insurance agents and brokers work on commissions; they’re paid by the insurance carrier you choose. Agents are a resource, but only if they offer plans from a range of carriers (you're limited by their options). You can check on https://medicarenavigators.com/medicare-advantage-plans/ before working with an agent to get an idea of the offerings in your area.
